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08050129 (2) CITY OF CUPERTINO '„` ' ��38.v.:an BUILDING DIVISION PERlyQ'r 5'^kCOL\':' i[t1CTQRl �FQAV11 BUIIDN ADD ESS: PERMIT NO. j.�45� JOHNSON AVE GIRISH BHARVIRKAR 08050129 NEWS NAME: FERMrr LSUEDATE GIRISH BHARVIRKAR 10456 JOHNSON AVE 05/15/2008 PHONE: SANITARY NO. CONTROL NO. ARCH=/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH O O LICENSED CON ItACTOR5 DECLARATION IOL)DesCrl tion V 1 hereby affirm thou 1 an limmed under Previsions of Chapter 9(commencing p vim Section 7M)of Division l ofW Business and Prfossiom Cade.and my licemc is RE-CONNECT ELECTRCTY&GAS TO EXSTNG METERS ° H in full foam mad meet _ at�'z Ucense ch. Lk.• _, Dam Ctmumctor, ' ARCHITECTS DECLARATION I understand my plats"I W used As public records Dyu Rain Licensed Porfestianal 3 OWNER-BUILDER DECLARATION 1 herehy aRrm met 1 em exempt form me ContraCmr'a Llemm Law for the C O o following mason.(Secdon 71131.5.Business and PrfeSdam Cale:My city or County $ which mquims a Permit ha construct aper.improve,demolish.or repair any structure ii prior its Lss..alw nymms quapplieam for such permit as file aligned summm, =0 the,he u licensed pursuant to W provisions of W commutes uses License Law(Chapow 9 Sq.Ft. Floor Area Valuation 'm 2 (commencing wire Section 7(1)(1)of Division 3 ofthe Business and Profession,Code)or $10 yu`< that Imu exempt thre from and the Weis for W alleged Com(don Any violation of &coon 7031.5 by any applianl for a permit subjects W aWliewt m a Civil penalty of Number OccU anC e ort Come than five hushed dollars(S51)(1). 37526045' P Y�'P 1,u oyer oldie pmapvty,m mY doPloycu wire wages u W'a rlc com6nssoen, will onmbevodt and t Liorda LAwdelor,ak(Sec.7041,Bovrea, and arty wh obu code:The Cannot and who Ww door ort apply lf an owrcs or Required Inspections man enywhobuilds provided schimprve who duessuin', Or offeedthrough his lay employees.building or improvement stem improvwmts art not ear ofc raRmed fur sale B. mildeer,W Wilding or enofpuring cord within ore Wild or improve on.for the(pose of builder will haw W broaden of proving Wt W did not Wild a improve for purpose of nk.3 Q 1.u owns of me property do mulu,ivd,comrammg vim ficammi Conuchars m construct me projea(Sec.7044.Business sed Professions Code:)The Comments'U. ttnm Law does not apply m an owner m property wbe Wilds or improves Wmon,and. who comrscts for tum prjects wire a Convacmr(s)licensed pur un,mthe Conacmh I.Law. ❑lameaemptun See .BB PCfa utia mason Dam&-5)k S�oB ORI ^ 'SCO PEN$ATIDN DECLARATION 1 hereby afRtm under pesWty m perjury ane of the felkving decludione ❑ m,.atW pounded far by Se CeNficm OfCanse Labor Code. Que Worlmrs ce o fCo� .coon, r provided far mi Section 1700 of W Isbor Code.(m W peRonnanm of W vale for rhich this pertni,is issued. 0 I have and will msicam.Workers Compansation Insurance,as acquired by&Non " 3700ofW labor Cook.fa the d..ofthe mark,fee which mi,permit is issued. ' My Wmkda Compensation 4uursnm caniv"Policy number am: - Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (lids sem cat,ced not be canplemo time permh is faane hunmedooll.(SAW) . a less.) I comifY mot in me polarnme c of me work for which this permit is iamed.l shall not employ my person in Amy maonerm as to become subject In ore�orlori n..do. Laws of Califamis.Oa• — V 1 S I� lf` Applicant u _ .�.f. NOTICE to APPUCAW Irslmsg this Ccorfema of Fsompoon,you should become subject At W Worker's Compcnskdon provisions of the Luba Code.you a= .J O forthwith comply with such Provisions"is permit shall Is,corned revoked. Z cONSTRUCf10N LENDING AGENCY l hominy aRsm that Wr its cmcdona .lendingg far 647 the perfonnaree of I L r�r Lo work for which this Permit is issued(See.3097.Civ.G) lid Q 1<ndm's Name i:7. z ICMeh Aodncu U Q 1 mndfy dust 1 have road this application W sum that the above mformatlun is ti.F Conal I agree m comply with all city and County ordln,rces and nate laws relating m 0 U Wilding construction,and hereby vuthori,e representatives ofmu city m Corer upon the 4 limbic-majudgm property for inspection purposes (We)agree to save,indemnify sed keep hdmlw Um City of Cupertino agunsl (ZImFiZ in Co mitaneofmacortaand expensXroah. they in any way sorra agvnsl.uid City V`,[ m APPLICANT of W RSTAN of Cots permit ^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON.POINf Issued by: Date �p SOURCE REG�y N5. /IASo v 5115110'8 Re-roofs SmDuum OfA mnnUCa�hamor— Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof ' Wmll me applicant or forum Wilding atupant sham or haedle hauroous material defined by oil Culauso Municipal Cooc,Chapter 9.13.and dm Health and Wety ,&Non 15533(4)? e ?❑Yu ONO All roofs shall be inspected prior to any roofing material being installed. Will thea licant or future building mea If a roof is installed without first obtaining an inspection,I agree to remove PP t W m use equipment or devices a which g Pe e�triet? ons air conuminmts u dcfinN by Ne Bay Ama Air QaNlly Management all new materials for inspection. ❑Ym ON. I have msA the h»asdms materials requircmmts underChapmr 695 offt Calila- mallealthkSalmyCade,Sations25505,25533aa125534.1underswddutifde Wilding ducat.1 cuncnoy have•aunt that it i,my rcapomibility at notify me oaupd,of me requirements 1ILL It most Ise mel prior At issum of a Cemikga,of cart Signature of Applicant Date o I15��8 owner lir to rt, ant Dam All roof coverings to be Class'A 'or better CITY OF CUPERTINO • 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Elk: Lot: APN . . . . . . . . : 37526045 . 00 DATE ISSUED. . . . . . . : 05/15/2008 RECEIPT #. . . . . . . . . : BS000004785 REFERENCE ID # . . . : 08050129 SITE ADDRESS . . . . . : 10456 JOHNSON AVE SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . . . OWNER GIRISH BHARVIRKAR ADDRESS . . . . . . . . . . : 10456 JOHNSON AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : GIRISH BHARVIRKAR CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY . . . . . . . . . . : GIRISH BHARVIRKAR ADDRESS 10456 JOHNSON AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 • TELEPHONE . . . . . . . . : FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BSEISMICR VALUATION 10 . 00 0 . 50 0 . 00 0. 50 0 . 00 1EPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00 IPPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00 - 1TRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 122 . 87 0 . 00 122 . 87 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 122 . 87 #1420 --------------- TOTAL RECEIPT 122 , 87 • nos o i 2-9 C� .. CITY OF CUPERTINO • CUPEkTINO GENERAL BUILDING PERMIT APPLICATION FORM APN # ? -7 Q 0 U 0 Date: 0 Sh S( 0,0 Building Address: I p4 S6 J o C nfo met 'wp Cf} I Igo I i{ Mailing Address (if different from building address): Owner's Name: Phone#: I Contractor: Phone: Fax: Contractor License#: • Cupertino Business License#: Contact: Phone: SIO 920 Ozeo1 etl I�1SH 6hr}�dt 21C�� Fax: Residential Lvj Commercial El Job Description: eecq.,r,e-ct `iAec-t1kr�C. 0-1-N C1 Is the pr9ject in the Wildland- Urban Interface Fire Area? Yes ❑ No ®— Building Permit Info: Bldg ❑ Elect Z-- Plumb ffj--" Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1 FR, I1FR ❑ 11, 111, V-IHR ❑ 11, 111, 1V V-N Valuation: Square Footage: Project Size: Standard ©�L-arge ❑ Ma or ❑ • Green Building: Please complete relevant portion of the Green Building/LEED Checklist& attach it to the application or if applicable, include in plan set & the sheet index. Points Achieved: For help, contact Build it Green at www.buildit reen.or :-1 CM OF CITY OF CUPERTINO cuPEkTriNO GENERAL BUILDING PERMIT APPLICATION FORM Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM 1 BTEMPPER Temporary Building Permit (good for B 30 days) 113BOILERI For the installation or relocation of ea M boiler/compressor to & including 3 horsepower, or ea absorption sys to & incl 100,000 Btu/h (29.3kw) 1 BBOILER2 Installation/relocation of ea M boiler/compressor over 3 horsepower to & incl 15 horsepower, or ea absorption sys over 100,000 Btu/h 1BBOILER3 Installation/relocation of ea M boiler/compressor over 15 horsepower to & incl 30 horsepower, or ea absorption sys over 500,000 Btu/h to & incl 1,000,000 Btu/h 1BBOILER4 Installation/relocation of ea M boiler/compressor over 30 hosepower to & incl 50 horsepower, or for ea absorption sys over 1,000,000 Btu/h to & incl 1,750,000 Btu/h I BBOILER5 Installation/relocation of ea boiler or M refrigeration compressor over 50 horsepower, or ea absorption sys over 1,750,000 Btu/h 1 BAPPLOTH For ea appliance or piece of equip M regulated by this Code but not classed in other appliance categories, or for which no other fee is listed in this code. 1 ELECINSP Other Electrical Inspections (per hour) E 1 MECHINSP Other Mechanical Inspections (per M hour) IPLMBINSP Other Plumbing& Gas Inspections P (per hour) 1MEETINGIHR Application Meeting B ,( CITY OF CUPERTINO CITY• OF GENERAL BUILDING APPLICATION CUPEkTINO FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group IGENRES or IGENCOM ACOUSTICAL REVIEW IACOUSFDW SFDWL/Duplex New B ]ACOUSRESAD SFDWUDuplex-Addition/Alteration B lACOUSCOM Multi-Family/Commercial B CHIMNEY'S ]CHIMNEY Chimney B 1CHIMNEYR Chimney Repair B FENCES 1 FENCE>6FT Non-masonry, over 6 ft in height B 1 FENCEMAS>6 Masonry, over 6 ft in height B FIREPLACES IFIREPLMAS Fireplace Masonry g IFIREPLFAB Fireplace Pre-Fabricated/Metal B I FLAGPOL>20 Flag pole (over 20 ft in height) B 1MODUSTRU Modular Structures B FOUNDATIONS 1FOUNDREP Foundation Repair B 1PILECAST Pile Foundation Cast in place concrete B 1 PILEDRIV Pile Foundation Driven (steel,pre- B stressed concrete 3 of 5 rCC - CITY OF CUPERTINO CITY OF GENERAL BUILDING APPLICATION • CUPERTINO FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or RETAINING 1GENCOM WALL(CONCRETE OR MASONRY 1RETSTN Standard (up to 50 ft) B IRETSP310 Special Design, 3-10' high (up to 50 `) B 1RETSP10 Special Design, over 10' high (up to B 50') 1 RETCRB< Gravity/Crib Wall, 0-10'high (up to B 50 ft 1RETCRB> Gravity/Crib Wall over 10' high (up to B 50 ft) SIDING IMF 1 SIDEST/BK Siding, Stone& Brick Veneer B (interior/exterior) 1 SIDEOTHER Siding all other B SKYLIGHTS 1 SKYL<10 SF Skylight less than 10 sf B I SKYL>10SF Skylight greater than 10 sf or B structural 1STAIRS Stairs-first flight/ea addt'l B STORAGE RACKS 1 SRACKS<=8 Storage Racks 0-8' high (up to 100 sf) B I SRACKS>8 Storage Racks over 8' high (up to 100 B st) 1STUCOAP Stucco Applications (up to 400 sf) B additional stucco application 4of5 (C� - CITY OF CUPERTINO CITY OF GENERAL BUILDING APPLICATION CUPEk'TiN0 FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM 1 WINREP Replacement windows/sliding glass B door (ea 8 windows) iWINMEWSTR New Window-structural shear B wall/masonry (includes plan ck fee / IEPERMITFEE Electrical Permit Fee E 1 MPERMITFEE Mechanical Permit Fee M 1 PPERMITFEE Plumbing Permit Fee P _EE IELCPLNCK Stand Alone Electric Pln Ck (hourly) E 1MECPLNCK Stand Alone Mechanical Pin Ck (hrly) M 1PLMBLNCK Stand Alone Plumbing Pln Ck (hrly) P 1 STPLNCK-(3 Hr Min Standard Plan Check (when no E/M/P) B when not over counter) hourly-stand alone / 1BSEISMICR Seismic Residential B 1BSEISMICO Seismic Commercial B / 1TRAVDOC Travel & Documentation B 1 1BUSLIC Business License B • 5 of 5 ism- Community Development c 10300 Torre Avenue E ✓ Cupertino CA 95014 Telephone(408) 777-3228 �UPEkTINO Fax(408)777-3333 Building Department JOB ADDRESS: lou Sb wkc,bon 4 re_, PERMIT # O p� 2J�-i woo GA- q 501�+ 0 5 CD OWNER'S NAME: Cu pu gt-1 PHONE #_VO —S'-ZO_ O GENERAL CONTRACTOR: o (3 FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting • Linoleum/ Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock • Tile � � osllSl 08 Owner/—Contractor Signature Date